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Luaran Transfer Embrio Simpan Beku pada Pasien Endometriosis Pasca Operasi dan Non Endometriosis yang Menjalani IVF di Klinik Permata Hati RSUP Dr. Sardjito Fatmawati, Rina; Widad, Shofwal; Dewanto, Agung
JURNAL KESEHATAN REPRODUKSI Vol 7, No 2 (2020)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.56940

Background: Endometriosis is a chronic condition that is influenced by the hormone estrogen which affects women of childbearing age, and is associated with pelvic pain and infertility. In Vitro Fertilization (IVF) is currently the most efficient assisted reproductive technology and its high success rate is often done for infertility therapy in women associated with endometriosisObjective: The aim of this study is to determine whether postoperative endometriosis affected pregnancy outcomes in patients underwent frozen embryo transfer in IVF / ICSI programs.Method: This Research is done with a retrospective cohort design. The data was taken from medical records, research subjects who met the inclusion and exclusion criteria. The research data was collected, processed and analyzed using SPSS 23. Univariate, bivariate and multivariate data analysis was carried out to determine the effect between variablesResult: There were 458 research subjects in this study. Endometriosis patients were 119 subjects (26%). 57 subjects were categorized as minimum-mild endometriosis (47.9%) and moderate-severe subjects as many as 62 subjects (52.1%). The biochemical pregnancy rate (36.31%) and clinical pregnancy (29.4%) in patients with endometriosis was slightly higher than in non-endometriosis. But statistically it did not affect success rate of achieving biochemical (p = 0.428; RR 0.89; 95% CI: 0.71-1.24) and clinical pregnancy (p = 0.535; RR 0.883; 95% CI: 0.63- 1.22). The rate of miscarriage in postoperative endometriosis patients was higher than non-endometriosis patients (88.6% vs 80.7%) but was not statistically significant (p = 0.294; RR 1.69; 95% CI: 0.61-4.67) . Biochemical and clinical pregnancies were significantly affected by age, infertility, endometrial thickness, embryo age and embryo quality. The incidence of miscarriage was affected by the ovarian stimulation protocol.Conclusion: Endometriosis post operative statistically has no effect on pregnancy outcomes in the IVF / ICSI cycle with frozen embryo transfer compared with another cause of infertility .Keywords:Endometriosis, In Vitro Fertilization, Clinical pregnancy, biochemical pregnancy, miscarriage

Perbandingan Luaran Ibu dan Bayi pada Khamilan dengan DM Gestasional dan DM Pregestasional di RSUP Dr.Sardjito Musa Limbu, Ely Yulianus; Nurdiati, Detty Siti; Dewanto, Agung
JURNAL KESEHATAN REPRODUKSI Vol 7, No 3 (2020)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.63114

Latar Belakang: Diabetes mellitus dapat terjadi pada 3-5% dari seluruh kehamilan. Hiperglikemia pada saat konsepsi dan pada awal kehamilan secara khusus selama organogenesis mengakibatkan enam kali lipat peningkatan risiko kecacatan pada perkembangan embrio. Bahkan peningkatan kadar glukosa yang ringan selama kehamilan dapat mempengaruhi ibu dan janin.Â Tujuan: Mengetahui gambaran dan prevalensi kehamilan dengan DM pregestasional dan DM gestasional di RSUP Sardjito. Membandingkan luaran ibu dan bayi pada kehamilan dengan DM pregestasional dan DM gestasional di RSUP SardjitoÂ Metode Penelitian: Penelitian ini merupakan penelitian kohort retrospektif. Data diambil dari rekam medis, subyek penelitian yang memenuhi kriteria inklusi dan eksklusi. Data penelitian dikumpulkan, diolah dan dianalisis dengan menggunakan SPSS 23. Dilakukan analisis data univariat, bivariat dan multivariat untuk mengetahui pengaruh antar variabelHasil: Penelitian ini melibatkan 74 subyek. Terdapat luaran ibu dengan ketoasidosis sebanyak 35 orang (47,30%), luaran bayi dengan makrosomia 15 kasus (20,27%), kelainan jantung 7 kasus (9,46%), dan mortalitas neonatal sebanyak 6 kasus (8,11%). Riwayat ANC < 4 kali berpengaruh secara signifikan terhadap kejadian mortalitas neonatal (OR 10,548; 95% CI 1,700-65,437; p = 0.011).\ Kesimpulan: Angka kejadian PGDM sebesar 44 kasus (59,46%) sedikit lebih tinggi dibandingkan GDM sebesar 30 kasus (40,54%) yang melakukan persalinan di RSUP Sardjito selama 5 tahun dari total 8857 kasus persalinan. KAD yang merupakan luaran ibu kejadiannya sebesar 47,30%, dan luaran bayi yang berupa makrosomia sebesar 20,27%, kelainan jantung pada bayi 9,46%, serta mortalitas neonatal 8,11%. Luaran ibu dan luaran bayi pada kehamilan dengan pregestasional diabetes yang dibandingkan dengan gestasional diabetes tidak berbeda bermakna pada penelitian ini.Â Kata kunci: pregestasional diabetes mellitus, gestasional diabetes mellitus, ketoasidosis diabetik, makrosomia, mortalitas neonatal, kelainan jantung pada bayi.Â

Analisis Pengambilan Keputusan Dokter Dan Pasien Terhadap Tindakan Seksio Permintaan Sendiri Berdasarkan Kaidah Autonomi Mappaware, Nasrudin Andi; Dewanto, Agung; Hakimi, Mohammad; Sastrowijoto, Soenarto; Kusmaryanto, Kusmaryanto; Mursyid, Muhammad
Window of Health : Jurnal Kesehatan Vol 5 No 01 (January 2022)
Publisher : Fakultas Kesehatan Masyarakat Universitas Muslim Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33368/woh.v0i0.1125

Introduction: Cesarean sections as the patientsâ€™ request have been widely carried out in Indonesian society. The freedom to make their own decisions, including the decision to perform a cesarean section, can have various impacts on the patient. Obstetricians who perform cesarean sections can be also affected if the final result of the operation does not fulfill the patient's expectations. Research objectives: Analyzing the decision-making of patients and doctors regarding cesarean section at the request with ethically responsible reason based on the principle of autonomy. Methods: Multi-methods with the explanatory sequential design approach. Research results: Medical indications are the main basis for doctors in making decisions. In addition, other considerations were found outside the medical indications which received by the informant for a cesarean section on request. Conclusions: Cesarean section on request is a dilemma between medical indications and the demands to ethically respect the rights of autonomy.

Cumulative cyclophosphamide dose and serum anti-Mullerian hormone levels in adolescent cancer survivors in Indonesia Mulatsih, Sri; Ayuandari, Sarrah; Rahmawati, Naafi Rizqi; Oktasari, Rizki; Dewanto, Agung
Paediatrica Indonesiana Vol. 63 No. 5 (2023): September 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.5.2023.376-82

Background As both the prevalence and survival rates of cancer in children and adolescents has risen, longer-term effects of cancer treatment must be investigated. High-risk gonadotoxic chemotherapeutic agents such as cyclophosphamide may affect the ovarian reserve and impact female adolescent fertility. Anti-Mullerian hormone is a reliable marker to assess ovarian reserve. Objective To assess for a possible correlation between the cumulative dose of cyclophosphamide and serum anti-Mullerian hormone (AMH) levels among adolescent cancer patients. Methods This cross-sectional study included 12-18-year-old adolescent female cancer patients who had experienced menarche and received cyclophosphamide therapy. We recorded the patients’ full history, including menstrual history, computed the cumulative dose of cyclophosphamide received, and measured serum AMH levels. The correlation test was performed to evaluate for a possible correlation between the cumulative dose of cyclophosphamide and ovarian reserve as represented by AMH levels. Results Out of 12 female adolescent cancer patients, three complained of disturbances in their menstrual cycles. Low levels of AMH (<1.5 ng/mL) were noted in five patients. Median cumulative cyclophosphamide dose was 1,000 mg/m2 (range 1,000 to 5,250 mg/m2). Cumulative cyclophosphamide dose was negatively correlated with serum AMH levels, but this correlation was not statistically significant (r=-0.316, P=0.318). Conclusion This study has not been able to show a correlation between cumulative cyclophosphamide dose and serum AMH level. Regular evaluation of fertility and involvement of fertility team is recommended in adolescents receiving high-risk gonadotoxic chemotherapeutic agents.

Analisis Pengambilan Keputusan Dokter dan Pasien Terhadap Tindakan Seksio atas Permintaan Sendiri Berdasarkan Kaidah Autonomi Mappaware, Nasrudin Andi; Dewanto, Agung; Hakimi, Mohammad; Sastrowijoto, Soenarto; Kusmaryanto, Kusmaryanto
JURNAL KESEHATAN REPRODUKSI Vol 10, No 2 (2023)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.71678

Latar belakang: Operasi sesar atas permintaan sendiri telah banyak dilakukan di masyarakat Indonesia. Kebebasan untuk menentukan keputusan sendiri termasuk keputusan untuk melakukan operasi sesar ini dapat menimbulkan berbagai dampak bagi pasien. Dokter spesialis obstetrik dan ginekologi adalah dokter yang melakukan operasi sesar bisa ikut terdampak tindakan yang dilakukan jika hasil akhir operasi tidak sesuai harapan pasien.Objektif: Menganalisis pengambilan keputusan pasien dan dokter terhadap tindakan seksio sesarea atas permintaan yang dapat dipertanggungjawabkan secara etik berdasarkan kaidah autonomy.Metode: multi methods dengan pendekatan explanatory sequential design.Hasil dan Pembahasan: Indikasi medis adalah landasan utama dokter dalam mengambil keputusan. Selain itu ditemukan pertimbangan lain diluar indikasi medis yang diterima oleh informan untuk dilakukan tindakan seksio sesaria atas permintaan.Kesimpulan: Seksio sesarea atas permintaan bersifat dilematis antara indikasi medis yang jelas dengan tuntutan untuk secara etis menghargai hak autonomy. Kata kunci:Seksio sesarea; autonomy; indikasi medis

Analisis Presumed Consent pada Penanganan Kasus Kegawatdaruratan Obstetri dari Persepsi Dokter dan Pasien Mursyid, Muhammad; Dewanto, Agung; Hakimi, Mohammad; Prabandari, Yayi Suryo; Mappaware, Nasrudin Andi
JURNAL KESEHATAN REPRODUKSI Vol 10, No 2 (2023)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.72541

Latar Belakang: Kondisi kegawatdaruratan obstetri, etika kedokteran dan hukum kesehatan memberikan tantangan tersendiri dalam pengambilan keputusan dokter. Pengambilan keputusan dalam kondisi kegawatdaruratan obstetri bervariasi tergantung kondisi medis pasien, dilema etik yang muncul ataupun aliran berpikir bioetika. Tujuan: Menganalisis presumed consent pada penanganan kasus kegawatdaruratan obstetri dari persepsi dokter dan pasien melalui aspek Kaidah Dasar Bioetika, Etika Klinik dan aliran berpikir bioetika.Metode: Metode kualitatif dengan pendekatan case study. Penelitian ini menggunakan desain holistic single case study design melalui wawancara mendalam kepada informan dokter dan pasien.Hasil dan Pembahasan: Dalam menyelesaikan suatu dilema etik, analisis prima facie menjadi solusi dalam pengambilan keputusan terhadap dilema etik bagi dokter dengan cara memilih prinsip yang lebih diprioritaskan berdasarkan kaidah dasar bioetika, etika klinik dan aliran berpikir bioetika.Kesimpulan: Implementasi metode presumed consent menjadi pilihan yang tepat dalam penanganan kondisi kegawatdaruratan obstetri berdasarkan aspek kaidah dasar bioetika, etika klinik dan aliran berpikir bioetika. Kata kunci: presumed consent; kegawatdaruratan obstetri; aliran berpikir bioetika; kaidah dasar bioetika; etika klinik

Pengaruh Kualitas Sperma terhadap Kualitas Embrio pada Pasangan yang Menjalani IVF di RSUP Dr. Sardjito Noor, Rahman; Ganap, Eugenius Phyowai; Dewanto, Agung
JURNAL KESEHATAN REPRODUKSI Vol 10, No 3 (2023)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.78031

Latar belakang: Kualitas sperma pria pada beberapa dekade terakhir berdasarkan studi mengalami penurunan. Penurunan kualitas sperma merupakan penyebab infertilitas pada laki-laki. Kualitas sperma yang menurun mempengaruhi kualitas embrio yang akan didapakan pada program IVF. Kualitas sperma dapat menjadi faktor prediktor kualitas embrio yang akan didapatkan pada program IVF. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan kualitas sperma dengan kualitas embrio pada pasangan yang menjalani IVF di RSUP Dr. Sardjito. Metode: Penelitian ini menggunakan metode kohort retrospektif. Pengambilan sampel menggunakan consecutive sampling. Subjek penelitian dibagi menjadi 3, yaitu kualitas sperma normal, perubahan ringan sperma dan perubahan berat sperma pada pasangan suami istri yang menjalani program bayi tabung (IVF/ICSI) di klinik infertilitas Permata Hati, RSUP Dr. Sardjito, antara 1 Januari 2019-31 Desember 2020. Hasil: Sampel yang memenuhi kriteria inklusi dan eksklusi sebanyak 319. Sampel tersebut terbagi menjadi 93 pada sperma normal, 144 pada perubahan sperma ringan, 82 pada perubahan sperma berat. Hasil penelitian ini terdapat hubungan yang bermakna antara kualitas sperma dengan kualitas embrio (p<0,001). Perubahan sperma berat secara statistik memiliki hubungan yang bermakna dengan embrio kualitas buruk (p<0,001). Pada perubahan sperma berat memiliki risiko 2,7 kali terhadap embrio kualitas buruk dibandingkan dengan sperma normal (OR=2,706; CI 95% 1,677-4,365). Kesimpulan: Kualitas sperma secara statistik memiliki hubungan yang bermakna dengan kualitas embrio pada pasangan yang menjalani IVF. Perubahan sperma berat memiliki risiko 2,7 kali terhadap embrio kualitas buruk dibandingkan dengan sperma yang normal

High Expression of PR-A and Low Expression of PR-B is Correlated with Inflammation in Endometrioma Cases Yuane, Erick; Dewanto, Agung; Widad, Shofwal
The Indonesian Biomedical Journal Vol 15, No 1 (2023)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v15i1.2114

BACKGROUND: Progestin therapy has been commonly used in endometriosis. The regulation of progesterone receptors B (PR-B) greatly affects the success rate of therapy in cases of endometriosis. The presence of tumor necrosis factor (TNF)-a in endometriosis triggers PR-B hypermethylation, decreasing PR-B expression and PR-B/A ratio that induce progesterone resistance. It may also occur in endometrioma. Studies regarding the distribution of PR-A and PR-B with TNF-a expression in endometriosis with endometrioma tissue samples has not been elucidated well. Therefore, this study was conducted to measure and compare the distribution of PR-A and PR-B expression, and to assess the effect of PR-B/A ratio on TNF-a in endometrioma and benign cysts.METHODS: A cross-sectional study was conducted by collecting paraffin blocks of endometriomas and benign cysts as controls, from patients undergoing surgery at Dr. Sardjito Hospital, Yogyakarta. Immunohistochemistry was performed to assess the expressions of PR-A, PR-B, TNF-a and PR-B/A ratio, to compared differences between endometriomas and benign cysts.RESULTS: Twenty-three endometrioma and 22 benign cyst tissue samples were collected. The mean PR-B expression and PR-B/A ratio were found to be lower in endometriomas than benign cysts, and mean expression of PR-A and TNF-a in endometriomas was higher than in benign cysts. However, there were no significant correlations between the expression of PR-A, PR-B, PR-B/A ratio, and TNF-a with endometriosis severity.CONCLUSION: In endometrioma cases, the expression of PR-A and TNF-a was higher, while the expression of PR-B and PR-B/A ratio was lower. However, there was no significant relationship between the ratio of PR-B/A and TNF-a.KEYWORDS: progesterone receptor, tumor necrosis factor-alpha, endometriosis, endometrioma, benign cyst, ovarian cyst

MMP-9 and TIMP-1 Promote Extracellular Matrix Remodeling in the Formation of Ovarian Endometrioma: in vitro Study on Chicken Chorioallantoic Membrane Sari, Vidia; Jenie, Riris Istighfari; Widad, Shofwal; Dewanto, Agung
The Indonesian Biomedical Journal Vol 15, No 1 (2023)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v15i1.2090

BACKGROUND: The invasion of endometrial tissue in the peritoneal layers is an important precursor to the formation of endometriosis. However, the mechanisms of the initial development of endometrioma remain unclear. This study aimed to explore the correlation between matrix metalloproteinase (MMP)-9 activity and tissue inhibitors of metalloproteinase (TIMP)-1 expression in the initial development of endometriosis through the invasion process of endometrial lesions in extracellular matrix (ECM) remodeling.METHODS: A total of 30 samples of endometrioma tissue were obtained from 24 women with endometriosis and examined at Dr. Sardjito General Hospital, Yogyakarta, Indonesia. The tissue was then implanted into a chicken chorioallantoic membrane (CAM) for five days to examine its invasion ability. The invasion scores were assessed using hematoxylin-eosin staining. MMP-9 activity and TIMP-1 expression were analyzed using gelatin zymography and western blot, respectively. The correlations between MMP-9 activity and TIMP-1 expressions with the invasion scores were analyzed using Spearman correlation tests with significance set as p<0.05.RESULTS: The results showed that there was a strong positive correlation between MMP-9 activity and invasion scores of endometriomas tissue (r=0.656; p=0.000). Meanwhile, expression levels of TIMP-1 had a weak negative correlation with the increase of invasion scores of endometrioma (r=-0.388; p=0.034). These results indicate the involvement of MMP-9 and TIMP-1 in the initial development of endometriosis during the ECM remodeling.CONCLUSION: MMP-9 activity and TIMP-1 expression were correlated with the invasion score of endometrioma tissue. This study provides evidence for understanding the mechanisms involved in ECM remodeling in the early process of endometriosis.KEYWORDS: endometrioma, extracellular matrix remodeling, MMP-9, TIMP-1

Informed Consent Tindakan Seksio Sesarea: Studi Metode Campur Penerapan Prinsip Bioetika pada Obstetri dan Ginekologi Saimin, Juminten; Prabandari, Yayi Suryo; Dewanto, Agung; Padmawati, Retna Siwi; Hakimi, Mohammad
JURNAL KESEHATAN REPRODUKSI Vol 11, No 2 (2024)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.100529

Latar belakang: Seksio sesarea dilakukan atas indikasi medis dan persetujuan pasien. Proses pengambilan keputusan terkadang menghadapi kendala dan dilemma.Tujuan: Menganalisis kelengkapan dan kepatuhan pengisian lembar informed consent dan aspek bioetika pemberian informed consent pada SC elektif.Metode: Menggunakan metode campur dengan pendekatan explanatory sequential design. Data kuantitatif untuk menilai kelengkapan dan kepatuhan pengisian lembar informed consent diperoleh dari rekam medik. Data kualitatif untuk menilai penerapan aspek bioetik diperoleh dari wawancara terstruktur dengan dokter Obgin, dokter umum jaga, bidan, dan pasien pasca SC.Hasil dan Pembahasan: Kelengkapan dan kepatuhan pengisian lembar informed consent adalah 72,5% dan 71,8%. Kedisiplinan dan perubahan rekam medik elektronik menjadi kendala pengisian formulir informed consent. Pemberian informed consent terkendala ketidakhadiran orang terpenting yang akan mengambil keputusan, kurangnya pemahaman dan pengetahuan pasien, dan pasien peserta asuransi kesehatan sehingga memunculkan dilema. Implementasi informed consent berdasarkan prinsip bioetika, otonomi, beneficence, non- maleficence, dan justice, digunakan untuk menyelesaikan dilema etik dalam pengambilan keputusan.Kesimpulan: Kelengkapan dan kepatuhan pengisian lembar informed consent belum mencapai 100%. Memilih prinsip bioetika yang lebih dominan nilai dan prioritasnya dengan analisis prima facie menjadi solusi untuk menyelesaikan dilema etik dalam pengambilan keputusan pada SC elektif.

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